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Original research
Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow
  1. Akiyo Sadato1,
  2. Shingo Maeda2,
  3. Motoharu Hayakawa1,
  4. Kazuhide Adachi1,
  5. Hiroshi Toyama3,
  6. Ichiro Nakahara4,
  7. Yuichi Hirose1
  1. 1Department of Neurosurgery, Fujita Health University, Toyoake, Japan
  2. 2Department of Neurosurgery, Nishichita General Hospital, Chita, Japan
  3. 3Department of Radiology, Fujita Health University, Toyoake, Japan
  4. 4Department of Comprehensive Strokology, Fujita Health University, Toyoake, Japan
  1. Correspondence to Dr Akiyo Sadato, Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi Prefecture 470-1192, Japan; asadato{at}fujita-hu.ac.jp

Abstract

Background The revascularization of carotid stenosis can increase ipsilateral cerebral blood flow (CBF). Occasionally, elevated CBF is also evident on the contralateral side, but this phenomenon is poorly understood.

Objective To analyze retrospectively the relationship between a contralateral CBF increase and several clinical and radiologic features.

Materials and methods We retrospectively analyzed 40 patients with unilateral cervical carotid stenosis treated by carotid artery stenting (CAS). Using 123I-iodamphetamine single-photon emission computed tomography (SPECT); we compared pre- and postoperative hemispheric CBF on both sides. We investigated the influence of the following five factors on the increase of the contralateral hemispheric CBF: stenosis grade (≥50% or <50%, according to the North American Symptomatic Carotid Endarterectomy Trial criteria); age; the presence of anterior and posterior communicating arteries; postoperative hyperperfusion on the stenotic side; and the presence of cerebral steal phenomenon during preoperative acetazolamide-challenge SPECT.

Results Following unilateral CAS, mean hemispheric CBF increased significantly on both sides: from 33.4±5.6 (mean ± SD) to 38.7±7.8 mL/min on the operated side (paired t test, p<0.001) and f35.4±5.4 to 39.2±7.2 mL/min on the contralateral side (p<0.001). In a general linear model, stenosis grade (≥50%) alone was significantly correlated with the increase of the CBF on the contralateral side (p=0.03).

Conclusion Revascularization by CAS for unilateral carotid stenosis can increase hemispheric CBF on both sides. Increase of the contralateral CBF is correlated with stenosis grade (≥50%).

  • carotid stenosis
  • stenting
  • CBF

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Footnotes

  • Contributors AS, MS: substantial contributions to the conception or design of the work, the acquisition, analysis, interpretation of data, and manuscript preparation; MH, KA: acquisition and analysis of the data for the work; HT, IN, YH: interpretation of data for the work and revising the manuscript critically for important intellectual content and final approval of the version to be published.

  • Competing interests None declared.

  • Ethics approval Institutional review board

  • Provenance and peer review Not commissioned; externally peer reviewed.

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